Peripheral Vascular System

Question 1

Arteries

Answer 1

Major arteries of the arm: Brachial, radial, ulnar

Major arteries of the leg: Femoral, popliteal, posterior tibia, dorsalis pedis

Question 2

Veins

Answer 2

1. Deep veins: with corresponding artery nearby (common site for VT)
2. Superficial veins: closer to skin surface (site for varicose veins)
3. Perforator veins: communicate between superficial and deep veins

Major veins: femoral, popliteal, saphenous veins

Question 3

Lympathic system

Answer 3

Consist of capillaries, lymphatic vessels and nodes, that provide fluid exchange

Form connection between arterioles and venules, allowing the circulatory system to maintain vital equilibrium

Question 4

VT: risk factors

Answer 4

Any factor that contributes to Virchow’s triad: (1) Venous stasis, (2) Hypercoagulability, (3) Endothelial damage

Causes: Reduced mobility, dehydration, increased blood viscosity

Question 5

Risk factors for lower extremity PAD

Answer 5

<50 yrs. of age with DM, AND one additional risk factor (smoking, dyslipidemia, HTN, hyperchomocysteniemia)

50-64 yrs. of age with h/o smoking or DM

> 65 yrs. of age

Leg symptoms upon exertion or ischemic rest pain (indicative of claudication d/t decreased blood flow)

Atherosclerotic coronary, carotid, or renal artery disease

Smoking

DM

Obesity

High BP

High cholesterol

FHX of PAD, heart disease, stroke

Excess levels of homocysteine

African-American descent

Question 6

Risk factors for venous stasis

Answer 6

Long periods of standing/sitting/lying down

Lack of muscular activity causes blood to pool in legs (increasing venous pressure)

Varicose veins further damage venous wall

Oral contraceptives (increase risk for clot)

Question 7

PVD: health promotion

Answer 7

Smoking cessation

Maintain/regulate blood sugar

Exercise regularly (30 min. 3x/week)

Lower cholesterol and BP (diet low in saturated fat, statin meds.)

Maintain healthy weight, BMI

Ankle-brachial index (ABI) screening >50 yrs. of age

Question 8

Subjective assessment

Answer 8

CC/HPI: Skin changes, claudication/heaviness/aching, varicose veins, persistent leg sores/open wounds, swollen legs/feet/glands or nodules; Men: erectile dysfunction

PMHX: Poor circulation in arms/legs, heart/vessel surgeries/treatments

FHX: Varicose veins, DM, HTN, CAD, hypercholesterolemia, elevated triglycerides

Lifestyle and health practices: Smoking, exercise, oral contraceptives, stress, interference of ADLs, meds., TEDs

Question 9

Objective assessment preparation

Answer 9

WIPE

Equipment: Gloves, cm. tape, stethoscope, doppler ultrasound probe, tourniquet, gauze, waterproof pen, BP cuff

Question 10

Inspection and palpation: arms

Answer 10

Inspect arm color, size, presence of edema, venous patterning; clubbing

Palpate fingers/hands/arms for temp., capillary refill <2 sec., epitrochlear lymph nodes; +2 radial, ulnar, brachial pulses

Allen test: determines latency of the ulnar artery by occluding radial and ulnar arteries with fist

Question 11

Inspection and palpation: legs

Answer 11

Inspect color (HYPOpigmentation d/t PAD; HYPERpigmentation d/t PVD), distribution of hair, lesions/ulcers, edema (lymphatic deficiency, PVD)

Palpate temp., superficial inguinal lymph nodes; +2 femoral, popliteal, posterior tibial, and dorsalis pulses

Question 12

Tests that inspect for varicosities and VT

Answer 12

1. Manual compression test: assess competence of varicose veins’ valves
2. Trendelenburg test: assess competence and retrograde of saphenous veins’ valves (by elevating legs until veins empty)
3. Homans sign: positive sign of VT if discomfort with dorsiflexion of foot; not very accurate

Question 13

Arterial insufficiency

Answer 13

Pain: intermittent claudication to constant/sharp/unrelenting pain, characterized by weakness, fatigue, cramping, aching, pain in calves/thigh/buttock with activity (but rarely in feet); relieved by rest and reproducible with same deg. of exercise

Pulses: diminished or absent; Skin characteristics: Rubor, hypo-pigmentation, thinning, shiny, low temp., atrophic (toe ulceration; painful wounds surrounded by healthy skin)

S/S: Trouble going up stairs, erectile dysfunction, sexual arousal difficulties

Question 14

Venous insufficiency

Answer 14

Pain: aching, cramping, characterized by heaviness and aching sensation; aggravated by standing or sitting and relieved by rest/elevation

Pulses: present, but difficult to palpate through edema; Skin characteristics: Hyperpigmentation, thickening, scarring (medial ankle ulceration; wounds are moderately painful surrounded by pigmented skin)

S/S of VT: Edema, pain, aches, erythema, warmth

Superficial phlebitis: inflammation of a superficial vein that can lead to VT